Aortic arch repair with antegrade selective cerebral perfusion using mild to moderate hypothermia of more than 28°C.

BACKGROUND

The temperature at circulatory arrest during open distal anastomosis is the most significant issue for aortic arch repair. In many institutions, there has been trend toward raising the temperature during circulatory arrest.

METHODS

Between 2004 and 2011, 164 consecutive patients underwent aortic arch repair with antegrade selective cerebral perfusion (ASCP) and moderate hypothermia. The patients were divided into two subsets (n = 84 each): group A (circulatory arrest at less than 27.9°C) and group B (at more than 28°C).

RESULTS

In group A compared with group B, mean temperature at circulatory arrest was 26° ± 1.0°C vs 29° ± 1.0°C, mean ASCP time was 72 ± 23 minutes vs 67 ± 17 minutes, and mean circulatory arrest time was 47 ± 21 minutes vs 44 ± 13 minutes. The 30-day mortality was 6.1% in both groups. Permanent neurologic deficit occurred in 8 patients (9.8%) in group A and in 5 (6.1%) in group B (p = 0.39). The incidence of renal failure requiring hemodialysis was 14.6% in group A and 3.6% in group B (p = 0.02). Postoperative respiratory failure requiring mechanical ventilation exceeding 3 days occurred in 12.2% of patients in group A and in 7.3% in group B (p = 0.04).

CONCLUSIONS

The temperature during ASCP can be safely increased to more than 28°C without increasing the rate of mortality and morbidity. ASCP with moderate hypothermia offered sufficient cerebral and distal organ protection.